Health Care FAQ


What is the Affordable Care Act (ACA)?

The Affordable Care Act was signed into law in March of 2010. It requires Americans and legal residents to have health insurance. In addition, large employers are required to offer affordable health insurance that meets minimum essential benefits; this requirement has been delayed until 2016.

What if I do not have health insurance in 2014

Any individual, family, or part of a family that does not have health insurance for more than 90 days in a given year will be subject to a penalty which will be paid through their tax return.

What if I cannot afford insurance

If your family’s income is under 400% of the Federal Poverty Level (FPL) you may qualify for the Premium Tax Credit (PTC) when obtaining health insurance through the Marketplace.

What is the Health Insurance Marketplace

The Marketplace or the exchange is the place where you get information about health insurance, purchase insurance, and obtain help with premiums and out-of-pocket costs. The open enrollment dates are as follows:

  • 2014: Now closed
  • 2015: November 15, 2014 – February 15, 2015
  • 2016 – forward: October 15th – December 7th

Read more about the Health Insurance Marketplace.

What is the Federal Poverty Level (FPL)

The amount of income a family needs for food, clothing, transportation, shelter and other necessities. It is updated yearly by the Department of Health and Human Services. The FPL is used to determine your eligibility for lower costs on insurance plans through the Marketplace and the Children’s Health Insurance Program (CHIP). FPL amounts are higher in Alaska and Hawaii.

What is a Premium Tax Credit (PTC)

A Premium Tax Credit is an advanceable, refundable credit that can be claimed on your tax return or received throughout the year to reduce the out-of-pocket expense towards insurance premiums.

How is the Premium Tax Credit (PTC) determined

The Premium Tax Credit (PTC) is based on a sliding scale. The higher your income, the lower the credit to help cover the cost of health insurance. If the PTC is more than your tax credit, you’ll receive the difference as a refund. However, if you received an Advanced Premium Tax Credit and your allowable credit on your tax return is less than what you received you will owe the difference. Read more about the Premium Tax Credit.

Since the amount I would pay for health insurance is based on my income, do I have to prove how much money I earn

Yes. The Marketplace will verify your income through your tax return on file with the IRS, Equifax, or by reviewing paystubs.

Is there anyone not required to get health insurance

There are some people or groups whom are not required to maintain health coverage. Some of these include:

  • Certain religious groups
  • Incarcerated individuals
  • If the lowest cost plan is more than 8% of their income
  • People who do not have to file a tax return
  • American Indians
  • Undocumented immigrants

For a detailed list of exemptions and applications click here.

What is the penalty if I do not have insurance

The penalty will be phased in on a four-year plan in an effort to give Americans time to get coverage.

  • 2014: 1% of taxable income, or $95 for 1 person, whichever is greater
  • 2015: 2% of taxable income, or $325 for 1 person, whichever is greater
  • 2016: 2.5% of taxable income, or $695 for 1 person, whichever is greater
  • After 2016: the penalty will be increased by reviewing the cost-of-living

If my employer offers health insurance, can I still use the Marketplace

Yes. However, you may not qualify for lower costs through the PTC if your job-based insurance is considered affordable and designed to pay at least 60% of the total cost of medical services. In addition, if you use the Marketplace your employer will not contribute to your premiums.

If I have a small business, do I receive any credit if I offer health insurance to my full-time employees

Yes! If you have a business with fewer than 25 full-time equivalent employees (FTEs) with average wages less than $50,000 you can get up to a 50% tax credit towards the premiums you pay through the Small Business Health Care Tax Credit.

What is the Small Business Health Care Tax Credit

To be considered for this credit your business must have 50 or fewer full-time employees (FTEs) or equivalent. This credit is available to small businesses only if they offer health care coverage through the Small Business Health Options Program (SHOP) Marketplace.

I am self-employed with no employees, where do I sign up for health coverage

You can get coverage through the Marketplace, not through SHOP.

Call 855-474-3677 for more information in your language and find the nearest bilingual office. At SiempreTax+ all inquiries, estimates, tax return reviews from previous years, and ITIN applications for you and your family are FREE.

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